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Arteriovenous shunting in patients with multiple myeloma and high-output failure
S Inanir1, R Haznedar, S Atavci
1Department of Nuclear Medicine, Gazi University Medical Faculty, Beşevler, Ankara, Turkey.
Insights
Arteriovenous shunting in the skeleton is a key factor in high-output cardiac failure for multiple myeloma patients. This study confirms the link between skeletal shunting and cardiac dysfunction in these individuals.
Area of Science:
- Cardiology
- Hematology
- Radiology
Background:
- High-output cardiac failure is a cardiovascular complication of multiple myeloma, often linked to extensive bone lesions.
- Investigating the underlying mechanisms is crucial for patient management.
Purpose of the Study:
- To investigate the presence and significance of arteriovenous shunting in patients with multiple myeloma and cardiac failure.
Main Methods:
- Eleven patients with multiple myeloma and congestive heart failure (cardiac index ≥ 4 L/min/m²) were studied.
- Arteriovenous shunting was quantified using intra-arterial injection of 99mTc-macroaggregated albumin (MAA) particles.
- Scans were analyzed quantitatively and correlated with cardiac index.
Main Results:
- All patients exhibited arteriovenous shunting (18.70% ± 17.29%), particularly in the femoral region.
- A significant positive correlation was observed between shunting values and cardiac index (r = 0.7899, p = 0.004).
- No correlation was found between anemia and cardiac index.
Conclusions:
- Arteriovenous shunting within the affected skeleton is a significant contributor to high-output cardiac failure in multiple myeloma.
- This finding highlights a specific mechanism driving cardiac complications in this patient population.
Unlabelled:
High-output cardiac failure is one of the cardiovascular problems associated with multiple myeloma and frequently seen in patients with extensive bone lesions. The purpose of this study was to search arteriovenous shunting in patients with multiple myeloma and cardiac failure.
Methods:
After the exclusion of other causes of congestive heart failure, 11 patients whose cardiac indices were higher than or equal to 4 liter/min/m2 were selected for the study (7 women, 4 men; mean age 59.64 +/- 8.92 yr). All patients had Stage II-III disease and femoral involvement in radiological examination. Arteriovenous shunting was determined by means of intra-arterial injection technique of 99mTc-macroaggregated albumin (MAA) particles. A quantitative analysis of all scans was performed, and the results were correlated with cardiac index.
Results:
Mean cardiac index was 4.33 +/- 0.36 liter/min/m2 in the study group. In all cases, arteriovenous shunting was detected (18.70% +/- 17.29%), and inhomogenous, increased radioactivity accumulation was revealed in the femoral region (lesion-to-background ratio 2.71 +/- 2.08). This zone corresponded to the area of infiltration in a radiograph. A significant correlation was found between shunting values and cardiac indices (r = 0.7899, p = 0.004, Spearman). Although all patients had varying degrees of anemia, we did not find such a relationship between the degree of anemia and cardiac index.
Conclusion:
Arteriovenous shunting within involved skeleton contributes significantly to the development of high-output cardiac failure in multiple myeloma.